EMPLOYEE INFORMATION Equal Opportunity - Accord

EMPLOYEE INFORMATION Equal Opportunity - Accord

*pri*
Must Be Completed By The Client
Client
Date of Hire
Hourly/Salary Rate
Full Time
/ Part Time
(30 hours or more)
Dept#
(30 hours or less)
Position
W/Comp Code
Benefit Group#
EEO Job Category *
#:
* 1. Executive/Sr. Level Officials & Mgrs 16. First/Mid-Level
Officials & Mgrs 2. Professionals 3. Technicians 4. Sales
Workers 5. Administrative Support Workers 6. Craft Workers
7. Operatives 8. Laborers & Helpers 9. Service Workers
EMPLOYEE INFORMATION
Equal Opportunity Employer
Please print complete name as shown on your Social Security card
Employee:
First Name
Middle
Last Name
Address:
City:
St.: ____ Zip:
County:
Social Security Number:
Email Address:
Phone:
Date of Birth:
Person to Contact In Case Of Emergency:
Phone:
I understand that if I am employed by Accord Human Resources, Inc. and leased to
, that such employment is for no definite period. It is the
policy of Accord Human Resources to comply with all applicable State and Federal laws prohibiting
discrimination in employment based on race, age, color, sex, religion, national origin, disability or
other protected classifications.
Signature:
*PRI*
TriNet Accord
Payroll Information
EMPLOYEE INFORMATION
Name:____________________________________________________ Social Security__________________________
(Nombre) Last/Apellido
First/Nombre
Middle/Inicial
(Seguro Social)
Address: ________________________________________________________________________________________
(Dirección) Street/Numero y Calle
Apartment Number/Numero del apartamento
City/Ciudad
State/Estado
Zip/Código Postal
Date of Birth:_________________________________ Home Telephone: _____________________________________
(Fecha De Nacimiento) Month/Mes Day/Dia Year/Año (Teléfono)
Area Code/Numero del Area
Number/Numero
Email Address:___________________________________________
(Dirección de Correo Electrónico)
Reasonable attempts will be made to forward all known wages to you. If we are unable to locate you, a $20 service fee will be deducted from any wages held by
Accord, unless prohibited by law, and such wages will be forwarded to the appropriate government authority.
Las tentativas razonables serán hechas para adelantarle todos sueldos conocidos. En caso de no localizarlo una compensación de $20 será descontado por servicios
de cualquier sueldo que usted tiene con Accord, a menos que sea prohibido por la ley, y tales sueldos serán adelantados a la autoridad apropiada del gobierno.
NATURE OF ACTION
Effective Date: _____________________________________________ Original Hire Date: _____________________
Month
Day
Year
Hour
Month
Day
❐ New Employment
❐ Regular (More than 30 hrs. per week.)
❐ Part-time (Less than 30 hrs. per week.) ❐ Part-time (Less than 20 hrs. per week.)
❐ Temporary ❐ Seasonal
❐ Rehire: Previous location
❐ Name/Address/Phone Change
❐ Transfer
❐ Leave of absence
❐ Compensation change; Next review date:
❐ Return from leave of absence
Year
In what state does this employee work?
PAYROLL DATA
Client Name: __________________________________
Employee Title: ______________________________
Client Number: ________________________________
Dept.: ______________________________________
Pay Rate: $_______________ ❐ Per hour
❐ Per ________
Pay Frequency: (choose one) ❐Weekly ❐Bi-weekly ❐Semi-monthly ❐Monthly
(choose one) ❐Hourly
Classification: (check one) ❐Exempt
❐Salary ❐Piecework ❐Commission
❐Non-Exempt
Workers’ Compensation Code: _________________________________
EEO Job Category: ________
1. Executives/Sr. Level
Managers
2. Professionals
3. Technicians
4. Sales
5. Administrative Support
6. Craft Workers (skilled)
7. Operatives (semi-skilled)
8. Laborers/Helpers
(unskilled)
9. Service Workers
16. First/Mid-Level Managers
Reason for Action (must be completed): __________________________________________________________________
Benefit Eligibility: ____ Benefit Group: # __________
____ Not Eligible
Paid Time Off:
____ Not Eligible
____ PTO Group: # __________
Approved By: ___________________________________________________ Date:_____________________________
Accord Designated On-Site Supervisor
(05/11)
Form W-4 (2015)
Purpose. Complete Form W-4 so that your employer
can withhold the correct federal income tax from your
pay. Consider completing a new Form W-4 each year
and when your personal or financial situation changes.
Exemption from withholding. If you are exempt,
complete only lines 1, 2, 3, 4, and 7 and sign the form
to validate it. Your exemption for 2015 expires
February 16, 2016. See Pub. 505, Tax Withholding
and Estimated Tax.
Note. If another person can claim you as a dependent
on his or her tax return, you cannot claim exemption
from withholding if your income exceeds $1,050 and
includes more than $350 of unearned income (for
example, interest and dividends).
Exceptions. An employee may be able to claim
exemption from withholding even if the employee is a
dependent, if the employee:
• Is age 65 or older,
• Is blind, or
• Will claim adjustments to income; tax credits; or
itemized deductions, on his or her tax return.
The exceptions do not apply to supplemental wages
greater than $1,000,000.
Basic instructions. If you are not exempt, complete
the Personal Allowances Worksheet below. The
worksheets on page 2 further adjust your
withholding allowances based on itemized
deductions, certain credits, adjustments to income,
or two-earners/multiple jobs situations.
Complete all worksheets that apply. However, you
may claim fewer (or zero) allowances. For regular
wages, withholding must be based on allowances
you claimed and may not be a flat amount or
percentage of wages.
Head of household. Generally, you can claim head
of household filing status on your tax return only if
you are unmarried and pay more than 50% of the
costs of keeping up a home for yourself and your
dependent(s) or other qualifying individuals. See
Pub. 501, Exemptions, Standard Deduction, and
Filing Information, for information.
Tax credits. You can take projected tax credits into account
in figuring your allowable number of withholding allowances.
Credits for child or dependent care expenses and the child
tax credit may be claimed using the Personal Allowances
Worksheet below. See Pub. 505 for information on
converting your other credits into withholding allowances.
Nonwage income. If you have a large amount of
nonwage income, such as interest or dividends,
consider making estimated tax payments using Form
1040-ES, Estimated Tax for Individuals. Otherwise, you
may owe additional tax. If you have pension or annuity
income, see Pub. 505 to find out if you should adjust
your withholding on Form W-4 or W-4P.
Two earners or multiple jobs. If you have a
working spouse or more than one job, figure the
total number of allowances you are entitled to claim
on all jobs using worksheets from only one Form
W-4. Your withholding usually will be most accurate
when all allowances are claimed on the Form W-4
for the highest paying job and zero allowances are
claimed on the others. See Pub. 505 for details.
Nonresident alien. If you are a nonresident alien,
see Notice 1392, Supplemental Form W-4
Instructions for Nonresident Aliens, before
completing this form.
Check your withholding. After your Form W-4 takes
effect, use Pub. 505 to see how the amount you are
having withheld compares to your projected total tax
for 2015. See Pub. 505, especially if your earnings
exceed $130,000 (Single) or $180,000 (Married).
Future developments. Information about any future
developments affecting Form W-4 (such as legislation
enacted after we release it) will be posted at www.irs.gov/w4.
Personal Allowances Worksheet (Keep for your records.)
A
Enter “1” for yourself if no one else can claim you as a dependent . . . . . . . . . . . . . . . . . .
A
• You are single and have only one job; or
Enter “1” if:
B
• You are married, have only one job, and your spouse does not work; or
. . .
• Your wages from a second job or your spouse’s wages (or the total of both) are $1,500 or less.
Enter “1” for your spouse. But, you may choose to enter “-0-” if you are married and have either a working spouse or more
than one job. (Entering “-0-” may help you avoid having too little tax withheld.) . . . . . . . . . . . . . .
C
Enter number of dependents (other than your spouse or yourself) you will claim on your tax return . . . . . . . .
D
Enter “1” if you will file as head of household on your tax return (see conditions under Head of household above) . .
E
Enter “1” if you have at least $2,000 of child or dependent care expenses for which you plan to claim a credit
. . .
F
(Note. Do not include child support payments. See Pub. 503, Child and Dependent Care Expenses, for details.)
Child Tax Credit (including additional child tax credit). See Pub. 972, Child Tax Credit, for more information.
• If your total income will be less than $65,000 ($100,000 if married), enter “2” for each eligible child; then less “1” if you
have two to four eligible children or less “2” if you have five or more eligible children.
G
• If your total income will be between $65,000 and $84,000 ($100,000 and $119,000 if married), enter “1” for each eligible child . . .
Add lines A through G and enter total here. (Note. This may be different from the number of exemptions you claim on your tax return.) a H
{
B
C
D
E
F
G
H
For accuracy,
complete all
worksheets
that apply.
}
{
• If you plan to itemize or claim adjustments to income and want to reduce your withholding, see the Deductions
and Adjustments Worksheet on page 2.
• If you are single and have more than one job or are married and you and your spouse both work and the combined
earnings from all jobs exceed $50,000 ($20,000 if married), see the Two-Earners/Multiple Jobs Worksheet on page 2 to
avoid having too little tax withheld.
• If neither of the above situations applies, stop here and enter the number from line H on line 5 of Form W-4 below.
Separate here and give Form W-4 to your employer. Keep the top part for your records.
Form
W-4
Department of the Treasury
Internal Revenue Service
1
Employee's Withholding Allowance Certificate
OMB No. 1545-0074
a Whether you are entitled to claim a certain number of allowances or exemption from withholding is
subject to review by the IRS. Your employer may be required to send a copy of this form to the IRS.
Your first name and middle initial
2
Last name
Home address (number and street or rural route)
3
Single
Married
2015
Your social security number
Married, but withhold at higher Single rate.
Note. If married, but legally separated, or spouse is a nonresident alien, check the “Single” box.
City or town, state, and ZIP code
4 If your last name differs from that shown on your social security card,
check here. You must call 1-800-772-1213 for a replacement card. a
5
6
7
Total number of allowances you are claiming (from line H above or from the applicable worksheet on page 2)
5
Additional amount, if any, you want withheld from each paycheck . . . . . . . . . . . . . .
6 $
I claim exemption from withholding for 2015, and I certify that I meet both of the following conditions for exemption.
• Last year I had a right to a refund of all federal income tax withheld because I had no tax liability, and
• This year I expect a refund of all federal income tax withheld because I expect to have no tax liability.
If you meet both conditions, write “Exempt” here . . . . . . . . . . . . . . . a 7
Under penalties of perjury, I declare that I have examined this certificate and, to the best of my knowledge and belief, it is true, correct, and complete.
Employee’s signature
(This form is not valid unless you sign it.)
8
Date a
a
Employer’s name and address (Employer: Complete lines 8 and 10 only if sending to the IRS.)
For Privacy Act and Paperwork Reduction Act Notice, see page 2.
9 Office code (optional)
Cat. No. 10220Q
10
Employer identification number (EIN)
Form W-4 (2015)
Page 2
Form W-4 (2015)
Deductions and Adjustments Worksheet
Note. Use this worksheet only if you plan to itemize deductions or claim certain credits or adjustments to income.
Enter an estimate of your 2015 itemized deductions. These include qualifying home mortgage interest, charitable contributions, state
1
and local taxes, medical expenses in excess of 10% (7.5% if either you or your spouse was born before January 2, 1951) of your
income, and miscellaneous deductions. For 2015, you may have to reduce your itemized deductions if your income is over $309,900
and you are married filing jointly or are a qualifying widow(er); $284,050 if you are head of household; $258,250 if you are single and not
head of household or a qualifying widow(er); or $154,950 if you are married filing separately. See Pub. 505 for details . . . .
$12,600 if married filing jointly or qualifying widow(er)
2
Enter:
$9,250 if head of household
. . . . . . . . . . .
$6,300 if single or married filing separately
3
Subtract line 2 from line 1. If zero or less, enter “-0-” . . . . . . . . . . . . . . . .
4
Enter an estimate of your 2015 adjustments to income and any additional standard deduction (see Pub. 505)
Add lines 3 and 4 and enter the total. (Include any amount for credits from the Converting Credits to
5
Withholding Allowances for 2015 Form W-4 worksheet in Pub. 505.) . . . . . . . . . . . .
{
6
7
8
9
10
}
Enter an estimate of your 2015 nonwage income (such as dividends or interest) . . . . . . . .
Subtract line 6 from line 5. If zero or less, enter “-0-” . . . . . . . . . . . . . . . .
Divide the amount on line 7 by $4,000 and enter the result here. Drop any fraction . . . . . . .
Enter the number from the Personal Allowances Worksheet, line H, page 1 . . . . . . . . .
Add lines 8 and 9 and enter the total here. If you plan to use the Two-Earners/Multiple Jobs Worksheet,
also enter this total on line 1 below. Otherwise, stop here and enter this total on Form W-4, line 5, page 1
1
$
2
$
3
4
$
$
5
6
7
8
9
$
$
$
10
Two-Earners/Multiple Jobs Worksheet (See Two earners or multiple jobs on page 1.)
Note. Use this worksheet only if the instructions under line H on page 1 direct you here.
Enter the number from line H, page 1 (or from line 10 above if you used the Deductions and Adjustments Worksheet)
1
2
Find the number in Table 1 below that applies to the LOWEST paying job and enter it here. However, if
you are married filing jointly and wages from the highest paying job are $65,000 or less, do not enter more
than “3” . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
3
If line 1 is more than or equal to line 2, subtract line 2 from line 1. Enter the result here (if zero, enter
“-0-”) and on Form W-4, line 5, page 1. Do not use the rest of this worksheet . . . . . . . . .
1
2
3
Note. If line 1 is less than line 2, enter “-0-” on Form W-4, line 5, page 1. Complete lines 4 through 9 below to
figure the additional withholding amount necessary to avoid a year-end tax bill.
4
5
6
7
8
9
Enter the number from line 2 of this worksheet . . . . . . . . . .
4
Enter the number from line 1 of this worksheet . . . . . . . . . .
5
Subtract line 5 from line 4 . . . . . . . . . . . . . . . . . . . . . . . . .
Find the amount in Table 2 below that applies to the HIGHEST paying job and enter it here . . . .
Multiply line 7 by line 6 and enter the result here. This is the additional annual withholding needed . .
Divide line 8 by the number of pay periods remaining in 2015. For example, divide by 25 if you are paid every two
weeks and you complete this form on a date in January when there are 25 pay periods remaining in 2015. Enter
the result here and on Form W-4, line 6, page 1. This is the additional amount to be withheld from each paycheck
Table 1
Married Filing Jointly
6
7
8
$
$
9
$
Table 2
Married Filing Jointly
All Others
If wages from LOWEST
paying job are—
Enter on
line 2 above
If wages from LOWEST
paying job are—
Enter on
line 2 above
$0 - $6,000
6,001 - 13,000
13,001 - 24,000
24,001 - 26,000
26,001 - 34,000
34,001 - 44,000
44,001 - 50,000
50,001 - 65,000
65,001 - 75,000
75,001 - 80,000
80,001 - 100,000
100,001 - 115,000
115,001 - 130,000
130,001 - 140,000
140,001 - 150,000
150,001 and over
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
$0 - $8,000
8,001 - 17,000
17,001 - 26,000
26,001 - 34,000
34,001 - 44,000
44,001 - 75,000
75,001 - 85,000
85,001 - 110,000
110,001 - 125,000
125,001 - 140,000
140,001 and over
0
1
2
3
4
5
6
7
8
9
10
Privacy Act and Paperwork Reduction Act Notice. We ask for the information on this
form to carry out the Internal Revenue laws of the United States. Internal Revenue Code
sections 3402(f)(2) and 6109 and their regulations require you to provide this information; your
employer uses it to determine your federal income tax withholding. Failure to provide a
properly completed form will result in your being treated as a single person who claims no
withholding allowances; providing fraudulent information may subject you to penalties. Routine
uses of this information include giving it to the Department of Justice for civil and criminal
litigation; to cities, states, the District of Columbia, and U.S. commonwealths and possessions
for use in administering their tax laws; and to the Department of Health and Human Services
for use in the National Directory of New Hires. We may also disclose this information to other
countries under a tax treaty, to federal and state agencies to enforce federal nontax criminal
laws, or to federal law enforcement and intelligence agencies to combat terrorism.
If wages from HIGHEST
paying job are—
$0
75,001
135,001
205,001
360,001
405,001
- $75,000
- 135,000
- 205,000
- 360,000
- 405,000
and over
Enter on
line 7 above
$600
1,000
1,120
1,320
1,400
1,580
All Others
If wages from HIGHEST
paying job are—
$0 - $38,000
38,001 - 83,000
83,001 - 180,000
180,001 - 395,000
395,001 and over
Enter on
line 7 above
$600
1,000
1,120
1,320
1,580
You are not required to provide the information requested on a form that is subject to the
Paperwork Reduction Act unless the form displays a valid OMB control number. Books or
records relating to a form or its instructions must be retained as long as their contents may
become material in the administration of any Internal Revenue law. Generally, tax returns and
return information are confidential, as required by Code section 6103.
The average time and expenses required to complete and file this form will vary depending
on individual circumstances. For estimated averages, see the instructions for your income tax
return.
If you have suggestions for making this form simpler, we would be happy to hear from you.
See the instructions for your income tax return.
*i-9*
*i-9*
*PER*
PERSONNEL INFORMATION Employee Name
Social Security Number
Marital Status
Client Name
Client Number
Emergency Contact Person
Relationship
Emergency Phone Number
Home
Cell
Work
The company’s EEO and harassment policies are included in the Employee Handbook. Please ask your supervisor
for a copy of this handbook if you have not received one.
SUPERVISORS: If the employee declines (or fails) to complete the section below, please complete it based on a
visual assessment.
Gender
Female
Male
Race or Ethnic Identity
White (not Hispanic or Latino)
Black (not Hispanic or Latino)
Hispanic or Latino
Asian (not Hispanic or Latino)
American Indian or Alaskan Native (not Hispanic or Latino)
Native Hawaiian or other Pacific Islander (not Hispanic or Latino)
Two or more races (not Hispanic or Latino)
Accord Human Resources Inc. wishes to comply with various laws and regulations which require us to file annual
statistical reports on our population. In addition, we wish to comply with the various laws and regulations which
protect the disabled veterans, veterans who served on active duty during the Vietnam era for more than 180 days,
and other protected veterans. Submission of this information by you is voluntary. Please be assured that you will not
be subjected to any adverse treatment if you do not provide the information requested. This supplement will be
maintained separately from your personnel file.
Check all that apply:
Special Disabled Veteran
Vietnam-Era Veteran
Newly Separated Veteran
Other Protected Veteran
Rev. 5/11
*PDA*
Payroll Deduction Authorization Agreement
Client Name____________________________________________ Client Number _______________________
Employee Name________________________________________ Social Security No.____________________
I hereby authorize TriNet Accord Human Resources to make deductions from any compensation that may
be due to me, up to and including the total amount for any of the following:
•
Uniformusagefee,ifrequiredbyclient.
•
Reasonablereplacementcostsofkeys,trainingmanuals,tools,supplies,uniforms,etc.suppliedtome
by the Client, which are not returned upon request.
•
EducationalexpensereimbursedtomebytheClient,ifterminationoccurswithinsixmonthsof
completion of the course.
•
Stoppaymentfeesforlostpayrollchecks.
•
Other(loan,advancedsickleave,companymonies,damages,etc.aspermissableunderstateandfederal laws)
I have read this agreement and fully understand its contents and agree to its terms.
Employee Signature________________________________________ Date _____________________________
Supervisor Signature_______________________________________ Date _____________________________
………………………………………………………………………………………………………………………
Payroll Deduction
Total Deduction Amount $___________________________________ Check Date ______________________
Amount Per Pay Period $___________________________________ Number of Pay Periods ______________
Explanation/Breakdown of Deduction ___________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
Supervisor Signature_______________________________________ Date _____________________________
(5/11)
*hba*
ACKNOWLEDGMENT PAGE
TriNet Accord has prepared this handbook as a guide for policies, benefits, and general
information which should assist you during your co-employment.
I understand that as co-employers, Accord Human Resources and my worksite employer (client) share
traditional rights and responsibilities held by an employer. These rights and responsibilities are allocated
between Accord and the client by contract. Some such rights and responsibilities are retained by the
client, some are assumed by Accord, and some are shared by the client and Accord as described in the
agreement for services.
The handbook should not be read as including the fine details of each policy nor as forming an express or
implied contract or promise that the policies discussed in it will be applied in all cases. THIS
HANDBOOK IS NOT A CONTRACT. Accord Human Resources reserves the right to make changes in
content or application of its policies as it deems appropriate, and these changes may be implemented even
if they have not been communicated, reprinted, or substituted in this handbook. Neither this handbook,
nor any other Company communication or practice, creates an employment contract. It is also understood
that nothing in this handbook or any other policy or communication changes the fact that employment is
at-will for an indefinite period and may be terminated at any time without cause and without notice by
you, Accord Human Resources or the Client.
I understand that no employee or representative of the Client or Accord Human Resources, other than the
Accord Board of Directors, has any authority to enter into an employment contract or to change the atwill employment relationship, or to make any agreement contrary to the foregoing. I understand that the
Accord Board of Directors is not authorized to make such contracts, changes, or agreements orally and
can only do so in writing. I acknowledge receipt of the employee handbook, and understand that my
continued employment constitutes acceptance of any changes that may be made in content or application
of the handbook.
____________________________________
_____________________
Employee Signature
Date
____________________________________
Print Employee Name
____________________________________
Witness
This signature page should be removed from the handbook and retained in the employee’s personnel file.
A duplicate of this signature page is provided on the inside back cover for the employee’s records.
*pri*
Debe Ser Completado Por El Cliente
Cliente
Fecha de Empleo
Horario/Salario
Tiempo Completo
/ Tiempo Parcial
(30 hours or more)
# Dept
(30 hours or less)
Posiciòn
Codico de Compensaciòn de Trabajadores
# Grupo de Beneficios
# de Categoria* de Trabajo del EEO
* 1. Ejecutivo/Oficiales y Gerentes de Nivel Mayor 16. Oficiales
y Gerentes de Primer/Secundario Nivel 2. Profesionales 3.
Tècnicos 4. Trabajadores de Ventas 5. Trabajadores de Apoyo
Administrativo 6. Trabajadores Hàbiles 7. Operativos 8.
Trabajadores y Ayudantes 9. Trabajadores de Servicios
INFORMACION DE EMPLEADO
EMPLEADOR DE IGUALDAD OPORTUNIDAD
Por favor escriba su nombre como mostrado en su tarjeta de seguro social
Empleado(a):
Nombre
Segundo Nombre
Appellido
Direcciòn:
Ciudad:
Estado: ____ Còdigo Postal:
Condado:
Nùmero de Seguro Social:
Direcciòn de Correo Electrònico:
Nùmero de Telèfono: (
)
Fecha de Nacimiento:
Contacto en Caso de Emergencia:
Nùmero de Telèfono: (
)
Yo entiendo que si soy empleado por Accord Human Resources, Inc. arrendado a
____________________________________, que tal empleo es por ningun tiempo definido. Es la
pòliza de Accord Human resources conformar con toda ley aplicable Estatal y Federal prohibiendo
discriminación de empleo basado en raza, edad, color, sexo, religión, origen nacional, incapacidad o
otra clasificaciòn protegida.
Firma:
*PER*
INFORMACION DEL PERSONAL
Nombre del empleado
Numero del Seguro Social
Estado Civil
Nombre de la Compañía
Numero de la Compañía
Persona para comunicarse en caso de emergencia
Relación
Contacto de Emergencia
Hogar
Celular
Trabajo
Las políticas de la compañía sobre el EEO y el acoso están explicadas en el libro de Referencias para los empleados.
Por favor pida una copia de este libro si no lo ha recibido.
Supervisores: Si el empleado niega o falla a cumplir la sección por debajo, por favor completela basado en su
evaluación visual.
Gender
Femenino
Masculino
Raza o Identidad Etnica
Caucásico o Blanco (no Hispano o Latino)
Afro-Americano (no Hispano o Latino)
Hispano o Latino
Asiático (no Hispano o Latino)
Indio Americano o Nativo De Alaska (no Hispano o Latino)
Nativo De Hawaii o otra clase de Isleño Del Pacifico (no Hispano o Latino)
De Dos o Mas Clases De Razas (no Hispano o Latino)
Accord Human Resources, Inc. desea cumplir con las leyes y los reglamentos que nos obligan a presentar informes
estadísticos anuales sobre nuestra población. Además, queremos cumplir con las diversas leyes y reglamentos que
protegen a los veteranos discapacitados, los veteranos que prestaron servicio activo durante la era de Vietnam por
más de 180 días, y otros veteranos bajo protección. La presentación de esta información por usted es voluntario.
Tenga por seguro que no será sometido a tratamiento desfavorable si no proporcionan la información solicitada. Este
suplemento se mantendrá separado de su archivo personal.
Marque las que correspondan:
Veterano con Incapacidad Específica
Veterano de Vietnam
Acaba de separarse de Veteranos
Otros Veteranos Protegidas
Rev. 5/11
*PDA*
Acuerdo de Autorización para Deducción de Nomina
Nombre del Cliente____________________________________________ Numero de Cliente ______________
Nombre del empleado________________________________________ Seguro Social____________________
Por medio de esta, yo autorizo a TriNet Accord Human Resources hacer deducciónes de cualquier compensación que
se me deba, incluyendo la cantidad total para cualquiera de lo siguiente:
•
Costodelusodeuniforme,siesrequeridoporelcliente.
•
Costosrazonablesdereemplazodellaves,demanualesdeentrenamiento,deherramientas,
materiales, uniformes, etc. proveídos por el cliente, que no regrese cuando lo requieran.
•
Reembolsódelcostodemieducaciónpagadoporcliente,silaterminaciónocurreenelplazode
seis meses de terminación del curso.
•
Pagodehonorariosparaparodechequesdenominadepagoperdidos.
•
Otro(préstamo,permisoporenfermedadavanzado,dinerodelacompañía,daños,etc.como
permisable bajo leyes estadadas y federale)
He leído este acuerdo y entiendo completamente su contenido y estoy de acuerdo con sus términos.
Firma del Empleado________________________________________ Fecha ____________________________
Firma del Supervisor_______________________________________ Fecha ____________________________
………………………………………………………………………………………………………………………
Deducción de Nomina
Cantidad de Deducción Total $___________________________________ Fecha del Cheque ______________
Cantidad por período de sueldo $_________________________Numero de períodos de sueldo _____________
Explicación de la deducción ___________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
Firma del Supervisor_______________________________________ Fecha ____________________________
(05/11)
*HBA*
PAGINA DE RECONOCIMIENTO
TriNet Accord ha preparado esta manual de referencia como una guía para políticas,
beneficios, y información general que pueda asistirlo durante su co-empleo.
Yo comprendo, que como co-empleadores, Accord Human Resources y mi empleador de lugar de
trabajo (cliente), comparten derechos tradicionales y responsabilidades tenidas por un empleador.
Estos derechos y las responsabilidades son asignados entre Accord y el cliente por contrato.
Algunos tales derechos y responsabilidades son retenidos por el cliente, algunos son asumidos por
Accord, y algunos son compartidos por el cliente y Accord como descrito en el acuerdo para
servicios.
La guía no debe ser leída como inclusive, los detalles finos de cada política ni como formando un
contrato o promesa expreso o tácito que las políticas discutidas serán aplicadas en todos los casos.
ESTA GUIA NO ES UN CONTRATO. Accord Human Resources reserva el derecho de hacer
cambios en el contenido o la aplicación de sus políticas como cree apropiado, y estos cambios
pueden ser aplicados, incluso, si ellos no hayan sido comunicados, reimprimidos, o han sido
sustituidos en esta guía. Ni esta guía, ni cualquier otra comunicación de la Compañía ni la
práctica, crean un contrato de empleo. También es comprendido que nada en esta guía o cualquier
otra política o comunicación cambia el hecho que el empleo es a voluntad por un período
indefinido y puede ser terminado en qualquier tiempo sin causa y sin aviso por usted, Accord
Human Resources, o el Cliente.
Comprendo que la Junta Directiva de Accord no es autorizada a hacer tales contratos, cambios, ni
acuerdos oralmente y sólo puede hacer así por escrito. Reconozco haber recibido la guía de
empleado, y comprendo que mi empleo continuado constituye aceptación de cualquier cambio
que puede ser hecho en el contenido o la aplicación de la guía.
____________________________________
_____________________
Firma de Empleado
Fecha
____________________________________
Nombre de Empleado
____________________________________
Testigo